Selective dorsal rhizotomy outcomes in mixed spasticity and dystonia cases.

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY

Child's Nervous System Pub Date : 2024-12-18 DOI:10.1007/s00381-024-06720-1

Ahmed Aly, Mostafa Elmaghraby, Andrew Dapaah, Benjamin Hall, Christine Sneade, Benedetta Pettorini

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Abstract

Introduction: This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia.

Method: A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale.

Results: Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved.

Conclusion: SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.

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痉挛和肌张力障碍混合病例的选择性背根切断术疗效。

摘要：本研究探讨选择性背侧神经根切断术（SDR）对以痉挛性和肌张力障碍混合表现的脑瘫（CP）患者肌张力障碍和肌张力障碍姿势的影响。方法：2013年5月至2022年9月，在英国一个超区域中心进行了一项前瞻性单中心研究。所有患有痉挛、肌张力障碍和/或肌张力障碍姿势的儿童均接受SDR。主要评价指标是肌张力障碍姿势的术前和术后评估。肌张力障碍严重程度采用Barry-Albright肌张力障碍（BAD）量表进行测量。结果：257例患者（3 ~ 18岁）接受了SDR治疗。43例有肌张力障碍，52例无肌张力障碍。在3个月的随访中（n = 29）， GMFCS水平趋于下降，在6个月时恢复到基线水平（n = 25）。2例患者术后需要调整药物。肌张力障碍组肌张力障碍水平保持不变。肌张力障碍组33例无变化，21例改善。结论：特别提款权可能有利于精心挑选的肌张力障碍或肌张力障碍姿势患者，而不会使这些疾病恶化。最佳的患者选择，手术目标的明确沟通和多学科参与是至关重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Child's Nervous System 医学-临床神经学

CiteScore

3.00

自引率

7.10%

发文量

322

审稿时长

3 months

期刊介绍： The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.